Lessons in humanity

Homeless man, care staff forge unexpected bonds

On Aug. 5, Patrick Conway was admitted to Beth Israel Deaconess Medical Center in acute pain. It did not take long for doctors to pinpoint the cause: an inoperable liver tumor that would probably kill Conway within two to three months.

When he got the prognosis a few days later, Conway, who is 56, took the news hard. "I was shocked," he says. Doctors overseeing his case said their goal was to minimize his discomfort during the days ahead.

Ordinarily, that would have meant giving Conway palliative medication and sending him home to loved ones. His situation was hardly ordinary, however, for he had no home to go to. For the past 16 years, Conway had been living on Boston Common. His only family consists of his friends and allies in the city's homeless community. The hospital weighed other options. Conway weighed his options, too.

"If he'd told us he wanted to go back to the Common to die, we would have understood and probably discharged him," says Dr. Nancy Torres-Finnerty. "Interestingly, he said he did not want to die on the streets. Ethically and medically, we felt justified in keeping him."

What happened next wasn't covered in the fine print of medical charts, hospital regulations, or Medicaid forms.

As his support team came to know Conway better, and as he focused more clearly on the time he had left, an unusual bond formed between caregivers and patient. The homeless man with virtually nothing to his name turned out to have a lot to offer others. And Conway, who'd always hated hospitals, found much to learn also, beginning with how love and compassion can enter a man's life in unforeseen ways.

"I can't say I'm making up for past mistakes, because I can't," Conway says, sitting on a park bench outside the West Campus Clinical Center, where he is being treated. "My time on Earth is short, I know. While I'm around, though, I want people to know the truth about someone like me, not what they read in the papers. That we're not bums or scary people."

At shelters, Conway continues, homeless people are often treated like statistics. "I'm very surprised how I'm treated here," he says softly. "They treat me like a human being, not like a piece of [trash]. Otherwise, I'd be back on the Common."

Up in his hospital room, Conway pulls out a card from Kohta Saito, a third-year medical student and former member of his treatment team who now works elsewhere in the hospital.

"You have taught me a lot beyond the science of medicine," Saito wrote. "You have taught me a lot about life." Saito also wrote that he kept a cross Conway had given him tucked inside his lab coat pocket.

"How often do you get a card like that?" muses Conway.

"I don't know anything about life on the Common, but he offered me a glimpse of that," Saito says. "You walk through it and don't notice the people there, but he told me about their personalities and gave me a picture of that community."

Saito isn't the only hospital staffer moved by Conway's circumstances and by the concern Conway has constantly shown for others. Dr. Melissa Mattison calls Conway "a breath of fresh air" and contrasts him with another patient she had last month, one who in many ways was Conway's opposite: conspicuously wealthy, medically treatable, and suffused with a sense of entitlement.

"I'd leave the man's room and head directly for Patrick's," Mattison says. "There he'd be, lying in bed and dying of cancer saying, 'You should really go home and take a day off. You look tired.' Some people have that gift, and Patrick is one of them."

And then there's social worker Sarah Porell, who's been working diligently to secure health coverage and hospice care for Conway. Most homeless patients have substance abuse or mental health issues that are readily apparent, Porell says, but not Conway. In fact, he's defied every stereotype homeless patients often arouse.

"With the homeless, we sometimes blame the victim," Porell says, "but often there's a much bigger story there. With Patrick, it's the fact that he had an education and a job yet took to the streets after a traumatic loss. Every time we meet, his story grabs me even more."

When asked to tell that story, Conway offers fragments that are not easily put together. In two extensive conversations, however, he supplies these details:

Born in upstate New York, he moved with his family to Northern Ireland when Conway was young. When he was a teenager, he and some family members got involved in skirmishes with the Irish Republican Army and several were killed in a London bombing. Conway went a different direction, though, finishing his high school years, getting married in 1969, and eventually moving back to the United States, where he settled in Pennsylvania and found work as a lithography printer.

After his daughter was born, Conway worked long hours to provide his wife and child with everything they might want. "We had a good life," he reflects. "Our daughter graduated from college and was going to be a sports medicine doctor."

A day after her college graduation in 1991, his wife and daughter were riding in a car plowed into by a drunk driver. The daughter died instantly. His wife was in a coma for 30 days, drifting in and out of consciousness. At one point, Conway asked her if she had any regrets. Yes, she said, that you worked too much and didn't spend more time with us.

"She was right, too. I hadn't," he says solemnly. "She died in my arms with a smile on her face." Grief-stricken and guilt-ridden, he says, "I sold everything I owned and gave the rest away."

Conway's life was suddenly adrift, as he moved from one place to the next. Months later, in late 1991, he landed in Boston. On his first night, huddled on Tremont Street, he nearly froze to death. Strangers carried him to Mass General. Not only did they save his life, but Conway had found his substitute family.

Working for a trash hauler was his only real employment after that, but a back injury ended that job, Conway says. On the Common, he slept on the steps of St. Paul's Cathedral and panhandled wherever the spare change was. Many of his friends, he says, were "stuck on stupid" and succumbed to drugs and alcohol, which he also admits to having abused in his past. He also admits to at least two arrests, for public drunkenness and assault. "I'm not proud of what I did," he says of the latter incident, which occurred this summer before his hospitalization. "But a man was groping one of my female friends. I felt it necessary to protect her, so I did."

The Rev. Joan Murray met Conway four years ago through Ecclesia Ministries, an organization ministering to Boston's homeless that Murray used to run. Conway was sitting on a grate outside the Park Street MBTA station, she recalls, and after speaking with him at length, she'd look for him whenever she took her street ministry to the Common. "Patrick was always taking care of others, mostly the ones who'd been drinking," says Murray. "I got the sense that had become his mission, to protect others. He is so not like what most people think of as the chronically homeless person."

After Murray left Ecclesia Ministries last month, she and her successor, the Rev. Kathy McAdams, have regularly visited Conway at Beth Israel. McAdams is helping plan funeral arrangements and a memorial service for Conway. Another social worker who's befriended Conway, Lenie Kuit of HopeFound, has been assisting with a book project of his about street life and the homeless. Conway has kept personal journals for years and hopes the project will be one of his lasting legacies.

Outside the hospital one recent morning, Conway sat on a bench feeding crackers to a flock of birds. On his lap was a health-proxy form that needed his signature. Asked whether he felt comfortable with his end-of-life arrangements, Conway nodded and puffed on a cigarette.

"Kathy will be the one to pull the plug when the time comes," he said. "If the pain gets too bad, they'll know what to do."